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EDITORIAL: Iowa’s Medicaid money mystery is growing old

Gazette (Cedar Rapids, IA)

July 07--When Gov. Kim Reynolds makes a promise, taxpayers rightfully expect her staff will make good on it. That hasn't been the case with Iowa Medicaid.

In early June, Medicaid Director Mike Randol offered lackluster answers to the Council on Human Services as to how his savings estimates were calculated. According to his projections, Iowans would save $140.9 million by the end of the fiscal year. But that figure appears to be tied to projected expenses of privatized Medicaid when compared to the last full year of the previous state-run program, with estimated 5 percent increases per year. Similar figures were used by the governor's office to justify its unilateral decision to privatize health care for roughly 600,000 low-income and disabled Iowans and, at that point, taxpayers were promised $232 million in savings during the 2018 fiscal year.

"I think it's important to understand that regardless of the methodology, there are savings," Randol told the Council, a body comprised of seven voting members appointed by the governor and four non-voting legislators.

Randol didn't explain why projected savings continue to shift. Nor did he explain why the state's savings estimate for this year tripled after he was hired to run the program late last year. No cumulative number has been offered to show program savings since privatized Medicaid began in April 2016.

As for reports of denied medical services and slow provider payments, Randol said such factors and health outcomes were not a part of his estimate. Council members were given no documentation to show or explain cost savings. And, afterward, Randol immediately left the meeting, avoiding reporters.

All of this after Gov. Reynolds promised reporters that Randol "would be happy to sit down with the media and walk through the process" of how he is calculating savings. Gazette reporters, trying to make good on that promise, received 15 minutes of access and, beyond verbal references to reduced emergency room visits, no insights into how savings have (or haven't) materialized.

Kirk Norris, president and CEO of the Iowa Hospital Association, says hospitals aren't seeing fewer Medicaid patients in emergency rooms, but higher concentrations of services not paid by for-profit insurance companies contracted by the state to provide managed care. He notes the Vinton hospital is owed $90,000 in emergency room visits alone.

More than two years has passed since Iowa moved to privatized Medicaid. This board, as well as others statewide, have demanded transparency. Unequivocally, we've said Iowa taxpayers have a right to know if the switch is saving money, how much is being saved and how those savings are being realized.

Amid these calls, nearly every agency remotely connected to Medicaid has sounded alarm bells. Iowans who rely on the program's coverage report denied services. Providers who care for these patients point to unresolved claims. Medical suppliers have presented unpaid bills.

The Iowa Office of the Ombudsman saw a 157 percent increase in cases connected to Medicaid managed-care organizations, leading the agency to issue one of the most scathing annual reports in its history.

Accurate numbers and a full, public accounting of the program isn't unreasonable and shouldn't be this difficult. Such transparency is, after all, what the governor promised.